Management of preoperative biliary drainage (PBD) in patients undergoing pancreaticoduodenectomy (PD) is still debated. Obstructive jaundice is associated with a proinflammatory state, impaired immune function and disturbances in coagulation. Patients with jaundice are at high risk to develop renal dysfunction and bacteriobilia. In this context, PBD was traditionally performed before surgery to improve postoperative outcomes.